Feeling ill? Might not be an app for that

When the iTunes Store began offering apps that used cellphone light to cure acne, federal investigators knew hucksters had found a new spot in cyberspace.

"We realized this could be a medium for mischief," said James Prunty, a Federal Trade Commission attorney who helped prosecute the government's only cases against health-app developers last year, shutting down two acne apps.

Since then, the Food and Drug Administration has been mired in a debate over how to oversee these new high-tech products. Government officials have not pursued any other app developers for making medically dubious claims. Now, both the iTunes store and Google Play store for Android users are riddled with health apps that experts say do not work, and in some case could even endanger people.

These apps offer quick fixes for everything from flabby abs to alcoholism, and they promise relief from pain, stress, stuttering, and even ringing in the ears. Many of these apps do not follow established medical guidelines, and few have been tested through the sort of clinical research that is standard for less new-fangled treatments sold by other means, a probe by The New England Center for Investigative Reporting has found.

While some are free, thousands must be purchased, ranging from 69 cents to $999.

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Nearly 247 million mobile-phone users worldwide are expected to download health apps in 2012, according to Research2Guidance, a global market-research firm.

In an examination of 1,500 health apps that cost money and have been available since June 2011, the center found that more than one out of five claims to treat or cure medical problems. Of the 331 therapeutic apps, nearly 43 percent relied on cellphone sound for treatments. Another dozen used the light of the cellphone, and two others used phone vibrations. Scientists say none of these methods could possibly work for the conditions in question.

'Bogus' claims

"Virtually any app that claims it will cure someone of a disease, condition or mental-health condition is bogus," said John Grohol, an online health technology expert. "Developers are just preying on people's vulnerabilities."

Satish Misra, a physician and managing editor of the app review website iMedicalApps added: "They take some therapeutic method that is real -- and in some cases experimental -- and create a grossly simplified version of that therapy using the iPhone."

To be sure, there are many outstanding health apps, particularly those intended for doctors and hospitals, that are helping to revolutionize medical care, according to physicians and others. Among the most well-regarded apps for consumers: Lose It for weight loss, Azumio to measure heart rates and iTriage to check symptoms and locate the closest hospitals with shortest emergency-room wait times.

But consumers have almost no way of distinguishing great high-tech tools from what Prunty called the "snake oil." Without government oversight or independent testing of apps, people mainly rely on developers' advertisements and anonymous online reviews, many of which are positive but some, such as this one, are not: "Shame on Apple for even allowing this piece of crap on here... It preys on people with health issues."

When contacted, Apple declined to discuss anything about its apps. The company has issued lengthy guidelines for app developers, which say it will reject apps that crash, have bugs or do not perform as advertised.

A Google spokeswoman also declined to discuss its apps or its rules for developers.

The FDA is drafting regulations that outline what types of health apps will need government approval before they can be marketed in the United States. But the regulations have been bogged down by debates, hearings and legislative back and forth.

A few private groups, meanwhile, are working to assess the quality of various apps. Misra's iMedicalApps gets health-care professionals to review software applications that mainly interest physicians. Happtique, a subsidiary of the Greater New York Hospital Association, is about to launch the nation's first app-certification service which will evaluate apps for safety and effectiveness. It will award some apps the high-tech equivalent of the Good Housekeeping Seal of Approval.

Misra, an internal medicine resident at Johns Hopkins Hospital, said he's most concerned about apps that claim to test or treat consumers for serious diseases. These apps can sometimes give inaccurate information or can lull people into ignoring symptoms that might need medical attention.

Cardiac Stress Test, for instance, says on Google Play (where it sells for $3.07) that it can determine "if you are ready for sports or if your heart is not in a healthy condition." A person takes his heart rate after performing 30 squats in less than 60 seconds, and enters it into the app's calculator, which then reports whether the user's heart is in shape for exercise.

"It's hard not to imagine how this app could give folks a false sense of security," Misra said, noting that assessing someone's cardiac status is not just a matter of looking at heart rate.

Simon Bertrand, who developed the app for his own use, said it is designed to help healthy people monitor their heart, similar to apps that monitor weight or body mass.

"If you are in poor health condition... go to see a doctor," he said in an email.

Later, in an interview by phone from France, Bertrand said his app was being offered for sale on Google Play within minutes of submitting it to the company.

"It's just a test," he said. "It's not an application that claims to cure."

Cellphone light as therapy

Apps that rely on cellphone light, meanwhile, cannot possibly have any therapeutic value, experts said. While light treatments can be used to relieve some medical problems, cellphone light is in the wrong spectrum and far too weak to make any impact at all, said the FTC's Prunty.

"Using the light of the cellphone is automatically suspect," Prunty said, which is why the agency decided last year to file complaints against two developers who claimed cellphone light could cure acne.

The FTC argued in its complaints that the developers' claims were "false or misleading." AcneApp, which sold for $1.99 on iTunes, claimed that blue light fought bacteria and red light helped heal skin. "Rest the iPhone against your skin's acne-prone areas for two minutes daily to improve skin health without prescription drugs," it said. The app was downloaded 11,600 times, according to the FTC complaint.

A similar app for Android phones, Acne Pwner, was downloaded 3,300 times, the FTC said.

AcneApp cited a study in the British Journal of Dermatology, which suggested that light therapy was almost twice as effective as over-the-counter blemish treatments. But the FTC said in its complaint that the study "does not prove that blue and red light therapy" effectively treats acne.

The two companies settled the complaints, without admitting any violation of the law, by paying fines of $14,294 in AcneApp's case, and $1.700 in Acne Pwner's case.

Gregory Pearson, the dermatologist who helped create AcneApp "was not making any claims of efficacy," said his attorney, Sesha Kalapatapu.

Cellphone lights are being marketing to treat other conditions too, including seasonal affective disorder (SAD), a type of depression that occurs during the winter because of lack of sunlight. But SAD experts say even the most powerful cellphone lights are far too weak to treat depression.

Even health apps that seem more conventional often have fundamental flaws. Many don't conform with clinical practice guidelines.

An app to help people that have ringing in the ears, or tinnitus, was sold in both the iTunes and Google Play stores until early August and contained multiple medical misconceptions.

"Ringing Relief Pro," which sold for $2.99, advertised itself as "an easy and inexpensive way to cure your tinnitus... Simply play the low frequency hum that sounds best to you for 90 seconds and your ears should ring no more!" It claimed that tinnitus occurs "when tiny hairs in your inner ear get stuck in the bent position and send false signals to the brain."

In fact, tinnitus is not caused by stuck ear hairs and can be a sign of many underlying medical conditions, including hearing loss, high blood pressure, allergies, and anxiety, says Rhonda Ruby, an audiologist who has treated patients for 35 years at the West Newton Hearing Center in Massachusetts.

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